Potential public health impact of the adjuvanted recombinant zoster vaccine among people aged 50 years and older in Beijing

Figures & data

Figure 1. Schematic overview of Markov structure – ZOster ecoNomic Analysis (ZONA) model. HZ: Herpes Zoster; PHN: postherpetic neuralgia. Figure originally published in D. Curran et al. 2017.²⁰

Table 1. Demographic, epidemiological and vaccine efficacy input values (base case)

Age (years)	50–54	55–59	60–64	65–69	70–74	75–79		80+	Source
Population size of age cohort in 2018	3,310,000		1,234,000	840,000	988,000			586,000	Beijing Statistical Yearbook 2019^Citation23
All-cause annual mortality probability (%)^†	0.44	0.56	1.14	1.96	2.94		4.93	80–84: 8.66 85–89: 13.39 90–94: 21.27 95–99: 30.70 100+: 41.95	Global Burden of Disease 2017^Citation24
HZ incidence (per 1,000 population)	8.03		10.33		11.41			14.00	Jiang et al. 201925
Proportion of HZ cases developing PHN (%)	6.30		10.30		11.40			30.50	Jiang et al. 201925
Proportion of HZ cases developing other HZ-related complications (%)									Jiang et al. 201925
Ocular	0.90		0.70		0.90			0.40
Neurological (meningitis)	0.30		0.40		0.00			0.20
Auricular	1.50		2.00		1.70			1.40
Other	0.60		0.80		1.30			0.60
HZ-related mortality (% of HZ cases)	0.0000				0.0020		0.0092	80–84: 0.0210 85–89: 0.0467 90–94: 0.1204 95–99: 0.1960 100+: 0.9476	Shiragami et al. 2019^Citation26
Mean hospitalizations (per HZ case)	0.014		0.026		0.039			0.081	Suo et al. 2019^Citation27
Mean outpatient visits (per HZ case)^‡	2.386		2.374		2.361			2.319
Initial HZ and PHN vaccine efficacy [1-dose]	90.0%				69.5%				van Oorschot et al. 2019;^Citation3 Curran et al. 2017^Citation20
Initial HZ and PHN vaccine efficacy [2-dose]	98.4%				97.8%
Annual RZV waning [1-dose]									van Oorschot et al. 2019;^Citation3 Curran et al. 2017^Citation20
Years 1–4 after vaccination	5.4%
Years 4+ after vaccination	5.1%
Annual RZV waning [2-dose]
Years 1–4 after vaccination	1.0%				3.6%
Years 4+ after vaccination	2.3%

HZ: herpes zoster; PHN: postherpetic neuralgia; RZV: recombinant zoster vaccine. ^†The all-cause mortality probability reported for age 100–104 years in the Global Burden of Disease Collaborative Network was used to represent that for age 100+ years in the current analysis. ^‡The average number of outpatient visits per age group was estimated by subtracting the reported proportion of hospitalizations per HZ case from the reported total 2.4 healthcare visits – which include both outpatient visits and hospitalizations – per HZ case across all age groups.

Table 2. Health outcomes and healthcare resource utilization in individuals ≥50 YOA (base case)

	No vaccination		Private market setting (RZV vaccination coverage: 5%)			Mass vaccination setting (RZV vaccination coverage: 50%)
	Cases		Cases	Cases avoided		Cases		Cases avoided
HZ	1,654,291		1,610,723	43,568		1,218,610		435,681
PHN	249,525		244,369	5,156		197,967		51,558
HZ-related complications other than PHN	57,572		56,002	1,570		41,870		15,703
Ocular	11,893		11,556	337		8,523		3,370
Neurological (meningitis)	3,450		3,345	105		2,403		1,048
Auricular	27,744		26,993	751		20,237		7,507
Other	14,485		14,107	378		10,706		3,779
HZ-related deaths	162		160	2		143		19
Healthcare resource utilization
Hospitalizations	69,470	68,045			1,425	55,223	14,247
Outpatient visits	3,900,829	3,797,690			103,139	2,869,441	1,031,387

HZ: herpes zoster; PHN: postherpetic neuralgia; RZV: recombinant zoster vaccine; YOA: years of age. The total cohort vaccinated was 347,900 in the private market setting and 3,479,000 in the mass vaccination setting analysis. Small discrepancies between subgroups and total cases may be present due to rounding.

Table 3. Cases avoided with RZV vaccination vs. no vaccination by age cohort, in the mass vaccination setting (base case)

	Age cohort (years)
N (%)	50–59	60–69	70–79	80+	Total (≥50 years)
HZ cases avoided	238,301 (54.7%)	132,179 (30.3%)	45,100 (10.4%)	20,101 (4.6%)	435,681 (100.0%)
PHN cases avoided	21,397 (41.5%)	16,818 (32.6%)	7,213 (14.0%)	6,131 (11.9%)	51,558 (100.0%)
HZ-related complications other than PHN avoided	8,578 (54.6%)	4,984 (31.7%)	1,618 (10.3%)	523 (3.3%)	15,703 (100.0%)
Ocular	1,952 (57.9%)	985 (29.2%)	352 (10.4%)	80 (2.4%)	3,370 (100.0%)
Neurological (meningitis)	683 (65.2%)	303 (28.9%)	22 (2.1%)	40 (3.8%)	1,048 (100.0%)
Auricular	4,076 (54.3%)	2,415 (32.2%)	734 (9.8%)	281 (3.7%)	7,507 (100.0%)
Other	1,868 (49.4%)	1,280 (33.9%)	510 (13.5%)	121 (3.2%)	3,779 (100.0%)
HZ-related deaths avoided^†	3 (13.3%)	6 (30.6%)	5 (24.6%)	6 (31.5%)	19 (100.0%)
Healthcare resource utilization avoided
Hospitalizations	5,597 (39.3%)	4,807 (33.7%)	2,214 (15.5%)	1,628 (11.4%)	14,247 (100.0%)
Outpatient visits	566,325 (54.9%)	312,422 (30.3%)	106,026 (10.3%)	46,615 (4.5%)	1,031,387 (100.0%)

HZ: herpes zoster; PHN: postherpetic neuralgia; RZV: recombinant zoster vaccine; YOA: years of age.

The total cohort vaccinated was 3,479,000 in the mass vaccination setting. Small discrepancies between subgroups and total cases may be present due to rounding.

^†A greater number and proportion of HZ-related deaths would be avoided in the older cohorts compared to the 50–59 YOA cohort, as (i) the estimated HZ-related death probability remains as 0% in the current model until the cohort reaches 70 YOA and older, (ii) RZV efficacy may wane over time, and (iii) not all vaccinated individuals in the 50–69 YOA cohort will reach 70–79 or 80+ YOA

Figure 2. HZ cases avoided with RZV vaccination per one million people over the respective age cohorts’ lifetime, compared with no vaccination, in the mass vaccination setting (base case). HZ: herpes zoster; RZV: recombinant zoster vaccine; YOA: years of age. Step increases over time (particularly pronounced in the 50–59 YOA cohort) are due to incidence being included as an age-specific step function

Figure 3. NNV to avoid one case of HZ and one case of PHN by age cohort (base case). HZ: herpes zoster; NNV: number needed to vaccinate; PHN: postherpetic neuralgia; YOA: years of age. NNV results are not affected by the vaccination coverage level, and thus do not differ between the private market and mass vaccination settings

Figure 4. Deterministic one-way sensitivity analysis: HZ cases avoided with RZV vaccination, compared with no vaccination. HZ: herpes zoster; RZV: recombinant zoster vaccine; YOA: years of age. Lower bound estimates are in blue and upper bound estimates are in green, with lower and upper ranges for inputs in brackets; refer to Supplementary Table 1 for details of inputs which varied by age group

Figure 5. Probabilistic sensitivity analysis: HZ cases avoided with RZV vaccination, compared with no vaccination. HZ: herpes zoster. The blue line shows the percentage of simulations averting at least the number of HZ cases shown on the x-axis

Figure 6. Scenario analysis assumptions and results comparing RZV vaccination with no vaccination, targeting individuals 50 YOA and older, estimating the number of HZ cases avoided (a) with increasing vaccination coverage and second-dose compliance; (b) with varying second-dose compliance, RZV efficacy, and its waning. ^aBase-case outcome for the private market setting analysis. ^bBase-case outcome for the mass vaccination setting analysis. Values for lower and upper bounds can be found in Supplementary Table 1. HZ: herpes zoster; PHN: postherpetic neuralgia; RZV: recombinant zoster vaccine; YOA: years of age

Figure 7. Plain language summary

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